My great-aunt chose medical assistance in dying (MAiD) in Alberta, Canada. It was sad – all death is – but it brought us comfort knowing that her death was autonomous, compassionate and mattered. And now, legislation threatens to take that choice away from others.
On March 18th, Alberta introduced Bill 18: the Safeguards for Last Resort Termination of Life Act – a bill that claims to “protect” patients but undermines the exact principles MAiD was built upon. Not only does this Bill dictate who may receive MAiD, but it dictates how clinicians may discuss and facilitate access to it. For a province heavily embedded in personal freedom, this Bill sharply undermines an Albertan’s right to autonomy.
An Attack on Ethical Medical Practice
One of the most troubling proponents of Bill 18, is its prohibition of physicians and nurse practitioners from referring patients beyond Alberta’s borders for MAiD eligibility assessments. This is a direct contradiction of medical providers’ moral obligation of duty to refer.
Duty to refer exists for this very situation. While it would be unethical to require medical providers to conduct legal treatments opposing their personal values (conscientious objection), medical providers cannot impede access to it. By banning all refers, Alberta has legislated clinical abandonment – leaving patients without a pathway to the care they are legally entitled to consider.
A Harmful Narrative about Marginalized Patients
Supporters of Bill 18 point to concerns that MAiD is a readily available and encourage treatment for marginalized patients. In a CBC news interview, a family physician stated that healthcare workers offer marginalized patients MAiD, rather than social supports for poverty or social isolation. While this elicits emotion, rightfully so, the national data and evidence prove this statement to be incorrect.
In Canada, Track 2 recipients (those who do not have a foreseeable death within 12 months) tend to have higher income and are less socially marginalized. In fact, 95% of Track 2 recipients with disabilities had supportive services, and no one can legally receive MAiD due to poor housing, poverty or inadequate supports.
In our current political climate, medical distrust is at an all-time high – false information and narratives based on fear, not facts, only deepens public distrust.
12-Month Prognosis Requirement Ignores Medical Reality
Bill 18 would limit MAiD eligibility to patients who are expected to die within 12 months. While this sounds straightforward, anyone who has worked in healthcare can attest to the fact that prognostication is inherently uncertain.
A qualitative study of MAiD assessors found that distinguishing Track 1 cases (reasonably foreseeable death) from Track 2 cases is often complex and highly individualized, relying heavily on clinical judgment rather than rigid timelines. Assessors emphasized that illness trajectories can vary widely, and decisions cannot be reduced to an arbitrary cutoff.
Federal reporting shows that Track 2 MAiD patients account for only 4.1% to 4.4% of cases. Yet, Bill 18 treats this small number of cases as justification to restrict access across the entire province.
Safeguards Already Exist
Alberta proposed Bill 18 with the misconstrued belief that patients need further protection. However, Canada already has one of the most comprehensive MAiD safeguard legislations in the world.
Under federal law:
- A minimum 90‑day assessment period for Track 2 cases
- Two independent practitioners to confirm eligibility
- Condition‑specific expertise by at least one assessor (or consultation with someone who has it)
- Full disclosure of all medical, palliative, disability, and community support options
- Voluntary, written, witnessed requests — with the option to withdraw at any time
These safeguards are explicit, robust and nationally standardized.
What Albertans Need
MAiD was created to offer patients enduring intolerable suffering a compassionate choice. Bill 18 undermines that choice by restricting information, limiting referral pathways and imposing unrealistic timelines.
My great-aunt had the dignity of choice at the end of her life, and Bill 18 threatens to take that away from others.
If Alberta wants to protect vulnerable people, then it should invest in increased medical funding, mental-health services, disability supports and social services – not restrict access to a federally protected medical option that allowed my great-aunt a death rooted in autonomy, compassion and evidence.
Brianne Helfrich, Bioethics PhD